Monday, July 20, 1998 Last modified at 1:22 a.m. on Monday, July 20, 1998

Employees unhappy with HMO policies

KENOSHA, Wis. - Oh yes, Russ Misiewicz has some thoughts about health maintenance organizations: Two years ago, he had chest pains and went to the emergency room. It turned out to be simply a pulled muscle in his left shoulder.

The shoulder pain quickly worked its way up to his head when he found that his HMO would not reimburse him for the $1,200 hospital tab because he failed to notify the insurance company within 24 hours of his visit. Late last week Misiewicz - a General Motors forklift operator, home during the afternoon because of the union's ongoing strike - took time out from his yard work to share his opinion about the managed health care industry.

"The health care system?" said Misiewicz, who lives in Burlington, a half-hour west of Kenosha. "How can I put it? Everybody wants to make money." He continued: "(My employer) GM is putting good money into this and paying the premiums, and I don't see why I should have to call these people."

Misiewicz's experience hardly compares to some of the horror stories about managed care that have been proliferating in the media lately: people dropping dead after having been denied care; badly injured patients lingering in emergency rooms waiting for their HMOs to guarantee coverage; patients suffering permanent injury after being denied referrals to specialist physicians.

But Misiewicz is not unusual in the sense that a growing number of people say they have had some sort of negative experience with an HMO or know someone who has. In a new nationwide Washington Post-ABC News poll, 63 percent of respondents said "protecting patients' rights" is an important election issue for them this year - at least 20 percentage points higher than reducing teen-age smoking or reforming the campaign finance system.

About 43 percent said they believe HMOs treat people unfairly, compared with 41 percent who said they treat people fairly. Sixty percent said they favor tougher government regulation of managed care programs compared with 27 percent who don't. And of those who favor regulation, two-thirds would do so even if it raised their health care costs.

Although 52 percent had an unfavorable opinion of HMOs, 80 percent of those enrolled in HMOs said they generally have been satisfied with their coverage, according to the poll. Representatives of the HMO industry argue that such apparently contradictory responses are the result of media saturation coverage and overheated political rhetoric that highlights the rare and outrageous failures of the system.

Most of the more than two dozen residents interviewed in this industrial small-town and dairy-producing swath of southern Wisconsin over the last few days expressed similar opinions to those found in the poll.

Many had specific complaints, such as having to haggle with their HMO over reimbursement for an emergency room visit or being forced to find a new doctor after their old one was dropped from a plan. Many also said they would favor some sort of increased government regulation to address problems. But few had any specific thoughts about what they would propose.

Politicians have sensed a growing anger and are making reform of the system that supplies health care to nearly 160 million Americans a top election-year priority. Democrats and Republicans in Washington have been promoting dueling reform proposals in a year when voters overall seem relatively content and there seem to be few major national issues.

Despite all the noise coming out of Washington, very few of those interviewed in Wisconsin said they consider managed care reform their top concern or an issue that will define how they vote in November. Typical were voters like Ceasar Passannante, who recently had six-way heart bypass surgery and was pleased with the service he received from his HMO. "It's costing me five bucks," he said.

On the other hand, he has heard the stories of people being denied care and thinks government should do something to ensure that everyone gets the same quality service he received. Like many Democrats, he said managed care reform still ignores the more crucial problem of the growing number of the uninsured people.

"I would say (managed care reform) is important to me, but I'm not a single-issue voter," said Passannante, who voted Democratic in the last presidential election and Republican in the last congressional election.

Several Republicans interviewed said they have conflicting feelings about the issue. "I hate to see more government regulation," said Candy Lamacchia, a teacher and a Republican voter from Kenosha. "But the HMOs are just so greedy, I think we're going to have to do something."

Democrats have been especially aggressive on the issue, seeking to gain a greater edge on an area of concern where they hold an advantage with voters. The poll suggested 53 percent of people trust Democrats to do a better job on health care, compared with 29 percent who favor Republican handling of the issue.

Here in southern Wisconsin, Democratic congressional candidate Lydia C. Spottswood, like so many Democrats running for office around the country, is making reform of the managed health care system a central campaign theme.

Spottswood, a nurse and former Kenosha City Council president, is seeking the House seat of Rep. Mark W. Neumann, Republican, who is running for the Senate. She has been promoting a plan much like the "Patient's Bill of Rights" proposed by President Clinton and Democrats in Congress. That plan would, among other things, allow patients to sue their HMOs for the care decisions they make. It also would create an appeals process for patients who have been denied care, allow patients to select a doctor outside the HMO network and let patients designate a specialist doctor as their primary care physician.

In her campaign speeches, Spottswood, 47, rails against what she refers to as over-compensated HMO officials. In an interview in her campaign office last week, she referred to an HMO executive who "is chauffeured in his Rolls-Royce," while his company scrimps on patient care. "This seems to be an area where people uniquely say it's high time we do something," said Spottswood, who won 49 percent of the vote in losing to Neumann in 1996. "There are enormous profits being enjoyed in this industry."

Nancy Wenzel, executive director of the Association of Wisconsin HMOs, said Spottswood's rhetoric is "destroying the confidence Wisconsin voters tell us they have in the system," noting that about 90 of the people in one recent statewide poll rated their health care coverage as excellent or good.

Spottswood's proposal would increase premiums by 10 percent and make health care unaffordable for thousands of Wisconsin residents, Wenzel said, adding, "The impact it would have would be truly devastating."

Spottswood's Republican opponent, Paul Ryan, has accused her of promoting big-government regulation, describing her plan as a step toward Clinton's failed universal health care plan of 1994. Ryan has said he shares concerns about problems with the system. But he said tax credits that put more money in people's pockets so they can expand their health care options are a better way to address the problems.

"There are abuses," said Ryan, 28, a native of Janesville who has spent the last few years working in Washington for Sen. Sam Brownback, R-Kan. "Patients need more access. But the key is not government-run health care but an empowered consumer. ... Generally her plan seems to me a knee-jerk toward more government regulation."

Ryan said he does not "hear that much about health care on the doorstep" and is concentrating on the issues that matter most to Wisconsin voters - taxes, Social Security and education.

In this community, midway between Chicago and Milwaukee, many of Spottswood's neighbors share her concerns about the quality of health care, but are uncertain about what should be done.

Kenosha resident Kristi Ambro, pregnant with her third child, said she has few complaints about the health care her family has received. However, she mentioned some concerns voiced by her husband, a doctor. "He feels that medical decisions should be left up to the physician," not the insurer, she said. "I guess the government should establish some bottom-line guidelines. But I am not in favor of socialized medicine."